Health/Medical Plans Claims Audits and Analytics Consultant
Are you passionate about delivering trusted advice that improves lives? Come work with us! Our Consultant, Health/Medical Benefits Claims Audits and Analytics has responsibility for leading health/medical benefits claims audits and analyses for our clients. Key Responsibilities: Perform as the lead health/medical claims audit consultant and/or CRM to clients. Provide strategic and business-oriented consulting advice on claims auditing practices and results, serving as counsel to clients and internal staff. Conduct planning meetings to identify/define client needs/issues and develop project plans and approaches that are responsive to client needs. Conduct technical analyses and quality reviews. Formulate conclusions and deliver client recommendations. Build and maintain effective rapport internally and with senior management in client organizations, vendors, and internally within the Company. Manage projects within scope, profitability and productivity targets. Lead business growth strategies and marketing initiatives to assist business development and cross-selling efforts. Respond to Requests For Proposals (RFPs) including preparing written proposals, providing pricing information, and defining project scope recommendations. Gather, use and share market intelligence to develop and introduce unique and/or new approaches to servicing clients. %3Cul%3E%3Cli%3E%3Cp class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;text-indent:-.25in;%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-family:Arial;%22%3E6+ years of health/medical claims audit and/or administration experience to include significant exposure to and expertise in electronic audit functions to include systems and tools relevant to an independent/third-party audit process; experience leading efforts to achieve revenue and/or profitability-oriented objectives; actuarial experience valued.%3C/span%3E%3C/span%3E%3C/p%3E%3C/li%3E%3Cli%3E%3Cp class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;text-indent:-.25in;%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-family:Arial;%22%3EUndergraduate degree. Advanced degree preferred.%3C/span%3E%3C/span%3E%3C/p%3E%3C/li%3E%3Cli%3E%3Cp class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;text-indent:-.25in;%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-family:Arial;%22%3EProficiency in Microsoft suite of products (i.e., Word, Excel, PowerPoint, and Outlook).%3C/span%3E%3C/span%3E%3C/p%3E%3C/li%3E%3Cli%3E%3Cp class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;text-indent:-.25in;%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-family:Arial;%22%3EData analysis expertise to include familiarity with SQL and Excel macros highly preferred.%3C/span%3E%3C/span%3E%3C/p%3E%3C/li%3E%3Cli%3E%3Cp class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;text-indent:-.25in;%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-family:Arial;%22%3EProject management and client servicing/relationship management skills.%3C/span%3E%3C/span%3E%3C/p%3E%3C/li%3E%3Cli%3E%3Cp class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;text-indent:-.25in;%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-family:Arial;%22%3EEffective interpersonal and relationship building skills with ability to build rapport with diverse audiences.%3C/span%3E%3C/span%3E%3C/p%3E%3C/li%3E%3Cli%3E%3Cp class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;text-indent:-.25in;%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-family:Arial;%22%3EProficiency in writing and oral presentation. Strong ability to problem solve, multi-task and manage multiple deadlines.%3C/span%3E%3C/span%3E%3C/p%3E%3C/li%3E%3C/ul%3E%3Cp class=%22MsoNormal%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3E%3Cstrong%3EJoin Segal:%3C/strong%3E%3C/span%3E%3C/span%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-weight:bold;mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EIf your qualifications align closely with what we have described, we encourage you to apply. Your unique background and skills matter because at Segal, we believe that different experiences and perspectives drive innovation and excellence. We are committed to creating a fair and transparent hiring process and all hiring decisions will be merit driven. If you require accommodation during the interview, please let us know. Thank you for considering Segal. We are excited to learn more about you!%3C/span%3E%3C/span%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Ci%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3E%3Cstrong%3EAbout Segal and its Total Rewards Program:%3C/strong%3E%3C/span%3E%3C/i%3E%3C/span%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-weight:bold;mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3ESegal is a privately owned, leading North American employee benefit, human resources and investment management consulting firm with%26nbsp;over 80 years of history%26nbsp;providing trusted advice that improves lives. Clients include public and private corporations, multiemployer trust funds, public sector entities, higher education institutions, institutional advisors, among many others.%3C/span%3E%3C/span%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22mso-bidi-font-weight:bold;mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3ESegal’s total rewards are part of what makes Segal%26nbsp;a special place to work. The current salary range for this position is %24101,500 - %24130,000.%26nbsp;%3C/span%3E%3C/span%3E%3C/p%3E%3Cp%3E%3Cspan style=%22font-family:Arial, Helvetica, sans-serif;font-size:11px;%22%3E%3Cspan style=%22line-height:107%;mso-ansi-language:EN-US;mso-bidi-font-weight:bold;mso-bidi-language:AR-SA;mso-fareast-font-family:%26quot;Times New Roman%26quot;;mso-fareast-language:EN-US;%22%3E#LI-Remote%3C/span%3E%3C/span%3E%3C/p%3E